PROJECT SUMMARY The incidence of Alzheimer's Disease and Related Dementias (ADRD) in American Indian/Alaska Natives (AI/AN) in the United States is growing. Compared to other ethnic and racial groups in the United States, the AI/AN population has a higher number of comorbidities associated with developing ADRD and substantial risk factors for early-onset, combined with significant health equity conditions that contribute to lower prevention and treatment options. These risks are exacerbated by limited knowledge of AI/AN resilience and culturally protective factors. Given the disease's progressive nature, early screening of ADRD in AI/AN would help identify the risk of dementia early and help in delaying its onset. Several dementia risk prediction models have been developed and validated in the White, Hispanic, and Black populations but are missing protective risk factors and information pertinent to culturally adapting early intervention models for AI/AN communities. We propose to conduct a longitudinal data analysis of the National Health and Aging Trends Study (NHATS) linked with Medicare enrollment data, supported by Rapid Assessment, Response and Evaluation (RARE) methodology to identify community-based perceptions of ADRD that impact early intervention efforts. The primary objective of this proposal is to 1) develop and validate an American Indian Dementia Index (AIDi) for AI/AN older adults. 2) In addition, the RARE approach and qualitative methodologies will identify unique protective and risk factors, needs, and cultural attributes of the tribal community, which will complement the AIDi.